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Pretransfer computed tomography delays arrival to definitive care without affecting pediatric trauma outcomes
Aodhnait S Fahy1, Ryan M Antiel1, Stephanie F Polites1
1Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55901, USA; Division of Pediatric Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55901, USA.
Insights
Pretransfer computed tomography (CT) scans in pediatric blunt trauma patients delay transfer to a pediatric trauma center (PTC) but do not worsen clinical outcomes or increase mortality.
Area of Science:
- Pediatric Trauma Care
- Medical Imaging in Pediatrics
- Emergency Medicine
Background:
- Children with significant trauma often require transfer to a specialized pediatric trauma center (PTC).
- Computed tomography (CT) imaging may be performed at referring hospitals before transfer.
Purpose of the Study:
- To investigate if pretransfer CT imaging in pediatric blunt trauma patients leads to delayed definitive care.
- To assess the impact of pretransfer CT on clinical outcomes.
Main Methods:
- Retrospective review of pediatric blunt trauma patients transferred to a Level I PTC.
- Comparison of outcomes between patients who received pretransfer CT and those who did not.
Main Results:
- Over half of transferred patients (52%) underwent pretransfer CT (chest and/or abdomen/pelvis).
- Pretransfer CT was associated with a significant delay in arrival time at the PTC (320 vs. 208 minutes).
- No significant differences were observed in median length of stay or mortality rates between groups.
Conclusions:
- Pretransfer CT imaging is common in pediatric blunt trauma cases.
- While pretransfer CT causes delays, it does not appear to negatively impact patient outcomes such as length of stay or mortality.
Purpose:
Children with thoracic or abdominal trauma, presenting to referring hospitals, may undergo CT imaging prior to transfer to a pediatric trauma center (PTC). We sought to determine if children who undergo pretransfer imaging experience a delay in definitive care and worse clinical outcomes.
Methods:
Pediatric blunt trauma patients transferred to our level I PTC were identified in this IRB approved study. Those transferred with CT imaging of the chest or abdomen/pelvis prior to transfer were compared to those transferred without imaging.
Results:
Of 246 patients with a mean age of 12.4±5.3years (64% male), 128 patients (52%) underwent chest (n=85) and/or abdominal (n=115) CT studies prior to transfer. Among those patients with pretransfer CT, 14% of CT scans were repeated. On multivariate analysis accounting for distance, time from injury to arrival at our PTC was significantly greater in children who underwent pretransfer CT (320±216 vs. 208±149minutes, p<0.001). Median length of stay (3 vs. 3days) and mortality (3% vs. 3%) were similar between groups (all p>0.05).
Conclusions:
A substantial number of pediatric blunt trauma patients underwent CT scans prior to transfer, which is associated with a delay in transfer but not worse outcomes.
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